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Clinton Aims for ‘AIDS-Free Generation’

Secretary of State Hillary Rodham Clinton on Tuesday called on the United States and other countries to use new scientific discoveries to create an “AIDS-free generation” in the world, but offered no clues about where the money would come from to finance that inspirational and costly vision.

Her speech was the first effort to publicly set such an ambitious goal, and administration officials scrambled to suggest ways that at least part of it might be paid for, including diplomatic pressure on governments in developing countries to spend more of their own money and political pressure on wealthy nations to contribute more.

The interventions she endorsed, based on successes in clinical trials in the last two years, include circumcision for men, multidrug cocktails for pregnant women, and getting drugs to patients as soon as they are first infected rather than years later when they fall sick.

It has taken eight years and tens of billions of dollars to get nearly seven million of the world’s sickest people on treatment. To treat all 34 million estimated to have the virus would be vastly more expensive. And, while about one million African men have been circumcised recently, mostly with American tax dollars, many more millions of men could benefit from the procedure.

The new focus on circumcision, mother-child transmission and “test-and-treat” actually represents the second major shift in policy since President George W. Bush announced in his 2003 State of the Union address what became the President’s Emergency Plan for AIDS Relief, or Pepfar.

Back then, the focus was on A,B,C — abstinence, being faithful and using condoms. Some money was earmarked for drugs, but there was always tension over whether to spend more on prevention or treatment.

Then, in its early days, the Obama administration sought to put greater emphasis on diseases that cost less to fight and on saving more lives. Measles shots, tetanus shots, clean birth kits, midwife training and other relatively inexpensive interventions — not programs aimed at AIDS treatment and prevention — were the core of Mr. Obama’s Global Health Initiative.

However, the president’s program has been criticized for lacking focus and has usually piggybacked on programs started to fight AIDS.

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Secretary of State Hillary Rodham Clinton called for a greater global effort to fight AIDS in a speech Tuesday at the National Institutes of Health in Bethesda, Md.Credit
Win Mcnamee/Getty Images

Groups that fight AIDS greeted Mrs. Clinton’s speech enthusiastically. Dr. Unni Karunakara, international president of Doctors Without Borders, called it “very encouraging to see the U.S. government wanting to turn the latest H.I.V. science into policies that will save lives while beginning to reverse the epidemic.”

Dr. Mark Dybul, the Bush administration’s last Pepfar administrator, who was abruptly dismissed by Mrs. Clinton when she took office, nonetheless attended the speech and praised it, saying it reminded him of the excitement he felt when Pepfar was launched.

At that time, lower prices for Indian generic drugs made treatment in Africa possible.

“And now the science has radically changed in the last 18 months,” he said.

While studies in subgroups like drug addicts or couples in which only one member is infected have concluded that immediate treatment lowers new infection rates, it has not been tested across whole cities or provinces in Africa. Mrs. Clinton mentioned plans to spend $60 million on trials to do that — the only time she put a price on anything.

“Her vision of an AIDS-free generation is ambitious, but we don’t have strong evidence yet that we can achieve that,” Dr. Over said.

Mrs. Clinton gave only one date, 2015, by which she hoped a goal would be reached: that no more mothers will infect their babies at birth or through breast-feeding. That is the source of about one-seventh of all new infections.

Many top administration health officials attended Mrs. Clinton’s speech, and sought to explain how it might be paid for at a time when the foreign aid budget is under severe pressure in Congress. The world now spends about $16 billion on AIDS per year. Getting just 15 million people (fewer than half of the 34 million infected) onto drugs by 2015 would raise the cost to $23 billion.

Dr. Anthony S. Fauci, the AIDS expert who heads the National Institute for Allergy and Infectious Diseases, pointed to recent developments that make treatment cheaper and more efficient: drug prices keep coming down, and local health workers run programs instead of doctors. Mrs. Clinton herself noted that the cost of keeping an African on treatment for a year has fallen to $335 from $1,100 seven years ago.

Dr. Eric Goosby, the administration’s global AIDS coordinator, said this was only the first of several speeches that administration officials planned to make on AIDS in the next few months. They “will get more specific about the money,” he said. “No one is trying to dodge the fact that it’s going to cost more.”

A version of this article appears in print on November 9, 2011, on Page A16 of the New York edition with the headline: Clinton Aims for ‘AIDS-Free Generation’. Order Reprints|Today's Paper|Subscribe